HIV Care
burden for over-worked healthcare staff while a robust monitoring and evaluation system (Step 5) will enable the benefits of a focus on care for patients and the health system to be seen. Over a period of time more elements can be incorporated and a wider network of referral agencies, both in the health and social care system and in the community can be developed. HIV treatment and care providers in many settings, from home-based and primary care to specialist palliative care teams in hospitals and even closed settings such as prisons, have successfully incorporated palliative
care into their work and found it beneficial to their work as well as to the patient. For many services, the barrier to getting started is lack of information on how to do it and access to information. We Care! Integrating palliative care into HIV Services: a practical guide for implement- ers fills that gap. The key to success is to have a vision of what the service will look like in the end for patients and staff but to implement it as a manageable process. As the positive results of integrated holistic care become evident, motivation will build to incorporate further interventions over time. It is all about making a difference.
Integration into ART clinics Chipini Health Centre in a rural district in Malawi provides the full range of primary health services. in addition to HIV voluntary testing and treatment services, it provides 24 hours a day, 7 days a week service with outpatient services, short-term in-patient care with 20 beds, maternal child health services (MCH) – antenatal care, post natal care, under fives’ immunisations, nutrition support and care, and maternity services with 20 beds Outreach home-based palliative care services to 76 local villages are fully integrated with the HIV treatment and care services providing symptom control support and help through volunteers.
Integration into primary healthcare In Mabvuku, Zimbabwe, the local NGO-run hospice provides clinical and outreach palliative care on a scheduled basis from the primary health clinic. The community groups in the area work together with the clinic and the hos- pice to follow up with patients and their families to provide basic care, teach family members how to care, loan as- sistive devices such as wheelchairs and bedpans, and provide adherence support and other forms of psychosocial support. The teamwork between the clinic staff, the hospice outreach team, and the community members makes it possible to meet many of the patients’ needs either directly or through referrals.
Integration into community and home-based care Good Hope home-based care (HBC) community caregivers in Sekukhune District, Limpopo Province, South Africa were trained in palliative care through the Integration Of Community Palliative Care project (ICPC). The project provided training and resources to improve the organisation’s capacity to provide palliative care The project linked the home-based care providers with palliative care trained local clinic staff. Together they provide clinical and home-based palliative care to patients and their families in the surrounding communities. Good Hope home- based care was also able to bring a pastor into the multidisciplinary team and this improved access to spiritual and social support, so the clinic and the HBC group are implementing a comprehensive service.
References 1.
FHI 360. Palliative care strategy for HIV and other diseases. Washington, DC: FHI 360, 2009.
2. Green K, Tran T, Nguyen NNT, Tran VN, Nguyen THA. Improving access to pallia- tive care among people living with HIV in Vietnam: Preliminary results from an intervention study. J Pain Symptom Manage 2010: 40: 31–4.
3. Harding R, Karus D, Easterbrook P, et al. Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence. Sex Trans Infect 2005; 81: 5–14.
4.
Ruiz M, Cefalu C. Palliative care program for Human Immunodeficiency Virus-infected patients: Rebuilding of an academic urban program. Am J Hospice Palliat Med 2011; 28: 16–21.
5. Kennedy C, Lindegren ML, Brickley DB, et al. Integration of maternal, neonatal and child health and nutrition, family planning and HIV: Current evidence and practice from a systematic Cochrane Review. Washington DC: PEPFAR, CDC and USAID, 2011.
6. Atun R, de Jongh Y, Secci F, Ohiri K, Adeyi O. Integration of targeted health interventions into health systems: a conceptual framework for analysis. Health Policy Planning 2010; 25: 104–11.
7. World Health Organization. Integrated health services: what and why? 2008
http://www.who.int/healthsystems/service_delivery_techbrief1.pdf.
8. Defilippi KM, Cameron Sue MA. Promoting the integration of quality palliative care: the South African Mentorship Program. J Pain Symptom Manage 2007; 33.
9. Selwyn PA, Rivard M, Keppell D, et al. Palliative care for AIDS at a large urban teaching hospital: program description and preliminary outcomes. J Palliat Med 2003; 6: 461–74.
10. Jameson C. The role of a palliative care inpatient unit in disease man- agement of cancer and HIV patients. S African Med J 2007; 97.
11. Downing J, Powell RA, Mwangi-Powel F. Home-based care in sub- Saharan Africa. Home Health Nurse 2010; 28: 298–307.
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12. Paleri A. Integrating palliative care into primary health care systems: the experi- ence from Kerala. Presented at the Consultation on HIV Palliative Care and Decent Care Values in the Context of Primary Health Care in Hanoi, Viet Nam: Asia, Hanoi, Vietnam, March 15–16, 2010.
13. Green K et al 2007. Adapted from Narain JP, Chela C and van Praag E. Planning and implementing HIV/AIDS care programmes: a step by step approach. New Delhi: WHO Regional Office for South-East Asia, 1998.
© Jo Voets
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